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Moderator:-Dr - Meenakshi Rawat (Senior Resident) Department of Paediatrics VCSGGIMS&R Srinagar Uttarakhand
Moderator:-Dr - Meenakshi Rawat (Senior Resident) Department of Paediatrics VCSGGIMS&R Srinagar Uttarakhand
Moderator:-Dr - Meenakshi Rawat (Senior Resident) Department of Paediatrics VCSGGIMS&R Srinagar Uttarakhand
Moderator:- •Presented by -:
Dr.Meenakshi Rawat •Akansha Verma 09
( Senior Resident ) •Akash Rawat 10
Department of paediatrics •Akhil Rana 11
VCSGGIMS&R Srinagar
•Akshay Kumar 12
Uttarakhand
DETAILED HISTORY
OF THE CASE
I am presenting case history of baby of Mrs Nikita, a 36 week gestation
age baby boy ,now 6 days old born to a 21 years old primigravida first
born of non consanguineous marriage ,Hindu by religion ,resident of
Sunderban , karanprayag.
Baby was born on 11 May 2024 at 8:30 am by vaginal delivery at HNB
Base Hospital.
Mothers LMP was on 2 September 2023 and EDD was on 8 June
2024.
Mrs Ankita ,who is the informant of the baby is his mother and her
reliability is good who belongs to lower middle class as per modified
BG Prasad scale .
The history was taken on 16 May 2024
CHIEF COMPLAINT
Patient was presented to Paediatrics OPD on 11 may
2024 with chief complaint of:
Vitals:
Pallor: absent
Icterus: absent
Cyanosis: absent
Lymphadenopathy: absent
EXPANDED NEW BALLARD SCORE(ENBS)
Acc. To ENBS -
Range of
gestation-34-36
weeks.
Total score- 26
APGAR SCORE
Interpretation-: score is
1
ANTHROPOMETRY
PARAMETE OBSERVED EXPECTED INFERENCE
R
1.Inspection :
1.Inspection:
chest shape and normal movements
No scar, sinus ,or deformity.
No apex beat visible
2.Palpation:
no local rise of temperature.
Apex beat felt in 4th intercostal space in mid-clavicular line.
Trachea central
No parasternal heave
3.Percussion:
could not be performed.
4.Auscultation:
Gastro-intestinal tract:
No cyanosis,no desaturation,no
Congenital heart disease Respiratory distress,preterm
murmur
Early onset neonatal sepsis Onset within 72 hrs of birth ,preterm No h/o maternal sepsis
• Inference
• Monocytosis
• (Monocytosis in newborn defined as
increases in number of monocytes in
blood, can be caused by various
conditions.
• Some of them are - -
Causes of monocytosis
• Inference
•
3)-Stool examination(13/05/2024)
• Physical examination-
• Color- greenish
• Consistency- Semi solid
• Mucous- absent
• Microscopic examination:-
• Ova- Not seen
• Cyst- Not seen
• Pus cell- (0-1) pus Cell/ HPF
• Occult blood test- weakly positive
4)-Urine examination report(13/05/24)
• Physical examination
Value Range
PH 5.0 4.6-8.0
Value Range
Investigations Report
CRP Negative
Serological investigations
• Monocytes- increased
• CRP-negative
• Normal LFT & KFT
• Post surfactant CXR - normal
• USG cranium - normal
• USG abdomen- normal
Management
RESPIRATORY DISTRESS
Respiratory distress is defined as the presence of tachypnea
(RR >60 per min), with chest retractions, grunting, and cyanosis.
Caption
Meconium Aspiration Syndrome (MAS)
• Neonates born through MSAF can aspirate
meconium into the lungs and develop
respiratory distress (meconium aspiration
syndrome; MAS)
Suspected RDS
Prophylactic surfactant to prevent RDS
ICU
Silverman scoring
(Loading
11/05/2024 inj Capnea IV OD 1day
dose) 30mg
(Maintaining
inj capnea dose)7.1mg IV OD 1day
Surfactant
Single dose - - -
given
Date Drug Dose Route Frequency Duration
Orogastric
12/05/2024 2ml Oral 2hourly 1day
feed
Inj
70mg IV BD 1day
Ampicillin
inj
5.6mg IV OD 1day
Gentamycin
IVF+inj
calcium 3.43ml IV hourly -
gluconate
Frequen
Date Drug Dose Route Duration
cy
Katori
13/05/2024 spoon 10ml Oral 2 hourly 1day
feeding
inj
70mg IV BD 1day
Ampicillin
Inj
Gentamyci 5.6mg IV OD 1day
n
Frequenc
Date Drug Dose Route Duration
y
Katori spoon
14/05/2024 12ml Oral 2hourly 1day
feeding
Inj
70mg IV BD 1day
Ampicillin
Inj
5.6mg IV OD 1day
Gentamycin
Date Drug Dose Route Frequency Duration
Ks
15/05/2024 feed+Alternat - Oral 2hourly -
e DBF
Inj
70mg IV BD 1day
Ampicillin
Inj
5.6mg IV BD 1day
Gentamycin
Multivitamin
1ml Oral OD 1day
s drop+Zn
Syrup
2.5ml Oral TDS 1day
ostocalcium
Drop
vitamin D3 1ml Oral OD 1day
(400:1)
Prevention of RDS
Antenatal prevention of RDS :
• corticosteroids to mothers who deliver at 24 - 34 weeks.
• Betamethasone : 12 mg/dose, 2 doses 24 hours apart.
• Dexamethasone: 6 mg /dose, 4 doses l2 hours apart (common in
India)